Health Systems Strengthening

   

MatCH focuses on health systems strengthening in KwaZulu-Natal through support for service delivery at public health facilities, capacity building and the provision of technical assistance. This work commenced in 2004 in eThekwini district with President’s Emergency Plan for AIDS Relief (PEPFAR) funding through United States Agency for International Development (USAID). The grid below lists the focus areas of health systems strengthening. 

   
Service Delivery  
Delivery of Antiretroviral Treatment at Primary Health Care Level  

MatCH currently supports over 70 public sector health care facilities to provide comprehensive HIV and related services, including antiretroviral treatment (ART). Initially ART was a hospitalbased, doctor-driven service offered only at accredited sites. This limited access to services. As a result, MatCH worked closely with the Department of Health (DoH) to implement a decentralised model where chronic clients on ART are “down referred” to clinics and managed by nurses. Building on the success of this programme, MatCH has been supporting clinics to deliver ART services. MatCH works closely with each facility to identify their specific requirements in order to support them in comprehensive implementation of new HIV services. This enables clinics to manage patients comprehensively, from HIV counselling and testing (HCT) to ART initiation, making the process quicker, supporting retention in care and increasing access to services. Once services are implemented, MatCH supports the sites to put in place systems that facilitate patient flow and the monitoring and evaluation (M&E) of services. Scaling up support to HCT is a key opportunity to address HIV prevention, treatment and care and to link clients to services after being tested. MatCH supports a number of HCT initiatives in the eThekwini District ensuring that positive clients can access CD4 testing and TB testing.

 

   
Medical Male Circumcision  

The United Nations Joint Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have recommended the provision of safe circumcision services in countries with high HIV and low circumcision prevalence, prioritising 12 to 30 year old HIV-uninfected young men to facilitate the quickest and greatest impact on HIV infection in the short term. In a response to this call for implementation in June 2010, MatCH is supporting the KZN DoH to roll out Medical Male Circumcision (MMC) and has been part of a team effort completing almost 7,000 MMC procedures up to March 2011. MatCH has supported the DoH to roll out MMC in non-medical settings or ‘camps’ combining a social and cultural programme supporting positive gender norms, HIV prevention and basic hygiene. These camps provide a unique opportunity for the participation of local civil society and communities in an HIV prevention effort by offering social and cultural interventions together with the medical procedure. The camps have also provided a valuable opportunity to promote MMC in communities prior to the rollout of services at health facilities. MatCH is now supporting district hospitals to set up MMC services, providing technical support, training, equipment and supplies such as MMC kits. MatCH is now supporting high volume fixed sites in 2011 to expand access to MMC services.

   

   
The Redevelopment of the KwaZulu-Natal Children’s Hospital  

In July 2010 the KZN Member of the Executive Council (MEC) for Health, Dr Sibongiseni Dhlomo launched the project to renovate and refurbish the KwaZulu-Natal (KZN) Children’s Hospital in Durban. The KZN Department of Health, MatCH and other relevant stakeholders are working together to renovate and refurbish the old Addington Children’s Hospital [renamed KZN Children’s Hospital] for utilisation as a comprehensive and integrated paediatric health service point for treatment, prevention and care, including psycho-social support services. The KZN Children’s Hospital will also build local capacity of paediatric health workers and researchers, as well as support community mobilisation and development. Processes will be used to improve outcomes with a focus on Millennium Development Goals 4 and 5; sustainability; standardisation of packages of care; and quality of care. The Children’s Hospital has been vacant since it was closed down by the previous government in 1984. A proposal to restore the Children’s Hospital was presented to the KwaZulu-Natal cabinet in October 2009 and was unanimously endorsed. It is anticipated that the project will take approximately 3 years to complete.
Visit the Children’s Hospital website for more information: www.kznchildrenshospital.org.za

 
   
Capacity Building
District Support Model

In 2010 MatCH supported the eThekwini district and area managers in drafting an integrated district operational plan. This plan provides the framework for integrated HIV and TB services at all facilities (including Prevention of Mother to Child Transmission and MMC), and implementing ART initiation at primary health care facilities. The plan also addresses human capacity development. MatCH works closely with the district to improve service delivery, to scale up comprehensive services, and to introduce new programmes. A key component of health systems strengthening revolves around improving the M&E of programmes and the utilisation of data for decisionmaking. MatCH provides support to facilities in eThekwini to set-up M&E systems, supporting data collection at sites using standardised tools and reporting via the District Health Information System. In addition, MatCH assists with target setting, conducting audits and verifying data reported to the South African government and training health care workers and data entry staff on M&E tools. MatCH conducts retrospective file audits to monitor the quality of care and treatment outcomes at sites. Findings are used to inform programme improvement, and provide baseline information to initiate defaulter tracing programmes, to improve data systems and quality of care at various sites, and to address loss to initiation and delays in accessing treatment.

Training

MatCH conducts training on a wide range of HIV and sexual and reproductive health (SRH) topics. All training materials are in line with South African and provincial guidelines and policies. The facilitators employ a combination of training methodologies to ensure training is effective and that learning techniques are stimulating and engaging. These include group work, role plays, on-site mentoring, coaching and peer assessments, in addition to didactic sessions. Participants are followed up on-site to ensure that learning translates into practice. Key training programmes since April 2010 have included HCT; ARV treatment guidelines; MMC promotion, screening and surgical procedures; female condom promotion and provision; and to improve the research capacity of SRH programme managers.


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